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The work of pharmacists at a hospital and its health board in Wales has been praised for cutting the use of antibiotics over the past five years.
Wrexham Maelor Hospital and its corresponding health board Betsi Cadwaladr were singled out for praise in a report published on 30 June by Public Health Wales, and one of the trust’s consultant microbiologists highlighted the involvement of pharmacists as essential in the drive to improve the appropriate use of antibiotics.
The report compares the results of five annual point prevalence audits conducted at all acute and community hospitals in Wales between 2011 and 2016. The authors note that the antimicrobial prescribing rate (the number of patients prescribed an antibiotic at the time of the audit) at Wrexham Maelor reduced from 36.5% in 2011 to 29.5% in 2016.
There was also a reduction at Bangor’s Ysbyty Gwynedd hospital from 42.7% in 2013 to 33.6% in 2014, with no notable increase in the subsequent two years. The two hospitals contributed to an overall reduction across the Betsi Cadwaladr University Health Board region from 35.8% in 2011 to 31.2% in 2016. The authors add that there was no significant change in prescribing rates at any other hospital over the five-year period.
Wrexham Maelor consultant microbiologist Deepannita Bhattacharjee said one of the main interventions they introduced at the hospital to help ensure appropriate antibiotic use was an antimicrobial pharmacist ward round every weekday on the medical admissions unit and an expansion of the role of ward pharmacists.
Bhattacharjee said other initiatives included expanding the role of the ward matrons and staff nurses to engage with pharmacy and microbiology to flag long or inappropriate antibiotic use; regular microbiology ward rounds in areas that use high quantities of antibiotics — such as intensive care and the renal unit — to ingrain automatic stop dates; and additional antimicrobial teaching for junior doctors.
“The driver was appropriate antibiotic use and not reduction in consumption,” she said.
“Although Clostridium difficile-associated colitis is a major driver, my long-term worry is antimicrobial resistance.”
Ysbyty Gwynedd-based antimicrobial pharmacist Charlotte Makanga explained that the antimicrobial team added broad spectrum antibiotic stickers to patients’ notes to highlight those who required review while they conducted their ward rounds — mainly within the admissions ward areas.
“The aim is to highlight to consultants where patients are prescribed broad-spectrum antibiotics and encourage them to stop these or replace them with more focused antibiotics once culture and sensitivities are available,” she said.
Makanga also highlighted the support of the hospital’s medical director as being instrumental in promoting the antimicrobial stewardship agenda.
“She has created a culture where pharmacists are encouraged and expected to challenge excessive and inappropriate antimicrobial prescribing,” she said.
While Makanga warned that the results of point prevalence audits should be interpreted with caution, she said she was encouraged that the results had shown repeated improvement.
“We have been working with a business analyst to help us use IT to identify areas of high antimicrobial usage more quickly — therefore, I am hopeful that this change in prescribing habit will continue and potentially improve further,” she said.
